Prepectoral Hammock and Direct-to-implant Breast Reconstruction in 10 Minutes: A Focus on Technique

• Main Authors: Gudjon L. Gunnarsson, MD, Jorn Bo Thomsen, MD, PhD
• Format: Article
• Language: English
• Published: Wolters Kluwer 2018-10-01
• Series: Plastic and Reconstructive Surgery, Global Open
• Online Access: http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001931

Background:. Breast animation deformity has sparked a reappraisal of the prepectoral implant placement in breast reconstruction. Our approach for direct-to-implant breast reconstruction (DIR) has evolved from a dual plane muscle/mesh coverage to a simple prepectoral hammock covering just the inferolateral part of the implant without the muscle. The aim of this study was to test the procedure in a prospective case series with emphasis on reconstructive outcome. Methods:. Twenty-seven patients undergoing nipple- or skin-sparing mastectomy without subsequent radiation therapy requesting a primary implant-based reconstruction were included from May 2016 to April 2017. Median age was 46 years (25–67). We registered comorbidities, complications, and long-term results of successful or failed reconstruction. Results:. Forty-seven DIR in 27 women, 20 bilateral, 7 unilateral. The median body mass index was 24 (17–31). The median time for mastectomy and DIR was 103 minutes (60–150). The inferolateral hammock consisted of Meso Biomatrix (34), Strattice (11), and Vicryl (2). The median implant size was 260 cc (140–345). Four complications (14%), 2 hematomas, 1 seroma, and 1 infection with partial nipple necrosis were all salvaged and reconstruction completed successfully. The median follow-up was 11 months (7–17). Conclusion:. The prepectoral inferolateral hammock, a swift one-stage procedure with a quick recovery, creates promising results in the presence of an adequate skin flap. The simplicity of the method has made it the authors first choice for DIR.